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Pertussis (Whooping Cough)

TMA physicians have identified pertussis as a public health concern in Texas. Reports of pertussis cases continue to come in from throughout the state. Many physicians promote the Tdap booster in their office, as the protection against pertussis from childhood vaccination can wane after five to 10 years.

Promoting Tdap

While the infection may be mild in adolescents and adults, the disease is highly contagious and a serious threat to infants who are too young to be vaccinated. Often family members who may not even realize they have the disease transmit the infection to these young babies.

“The only way to stop pertussis’ growth is for adults to get the Tdap vaccine,” says Donald Murphey, MD, member of TMA’s Committee on Infectious Diseases, and a TMA Be Wise — ImmunizeSM advocate. “Get the shot and shield yourself from getting sick, and maybe protect an infant from a much worse fate.”

Preventing pertussis outbreaks is a shared responsibility of physicians and a local and state public health system. TMA physicians took a step toward this goal when they successfully advocated for the passage of a law requiring the hospitals, birthing centers, physicians, or midwives who provide prenatal care to provide information on pertussis to postpartum women . This will help protect, or “cocoon,” newborns from contracting pertussis.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) recommends other immunization strategies as well. This includes encouraging Tdap for adults over the age of 65 as well as administering Tdap in emergency departments for wound management

Vaccine Recommendations

The Tdap vaccine is recommended for use in adolescents and adults, who may contract pertussis as a mild infection and transmit the disease to young babies. ACIP recommends Tdap for the following groups:

Pregnant women in their third or late second trimester who have not previouslt received tdap booster,

Postpartum women who have not previously received a Tdap booster,

Adults age 65 and older,

All adolescents and adults who anticipate having close contact with an ingant less than 12 months old, preferably at least 2 weeks before beginning contact with the infant, and

Health care personnel

ACIP recommends Tdap be administered regardless of interval since last tetanus or diphtheria toxoid-containing vaccine.

Health Plan Reimbursement Policies for Tdap Vaccination

The following chart provides information on the tdap coverage policies of major insurers as well as Medicare and Medicaid. Both tdap and Dtap are included on the new Affordable Care Act’s list of vaccines that patients can receive with no cost-sharing when the services are provided in-network. This requirement takes effect in plan years that begin on or after September 23, 2010.

● Persons age 7 and over without further restrictions or edits when administered in a physician office. This includes pregnant women.

Blue Cross Blue Shield

Contact health plan directly

Medicare

●Tdap is not covered as a medical benefit under traditional Medicare. Medicare Part D carriers may cover preventive immunizations as a pharmacy benefit, but are not required to.

Texas Medicaid

●The Texas Vaccines For Children Program provides vaccines for Texas Medicaid clients 0-18 years according to the recommended schedule approved by the following: ACIP; AAP; AAFP. Vaccines distributed through TVFC will not be reimbursed through Texas Medicaid.

●Vaccines may be reimbursed through Texas Medicaid at a fee determined by HHSC when the vaccine is medically necessary. The following immunizations are identified and recommended by the ACIP as medically-necessary for clients who are 21 years of age and older (this list is not all-inclusive):Tetanus - 90703, 90714, 90715, 90718

NOTICE: This information is provided as general guidance on reimbursement issues. Although TMA has attempted to present materials that are accurate and useful, some material may be outdated and TMA shall not be liable to anyone for any inaccuracy, error or omission, regardless of cause, or for any damages resulting therefrom. Certain links and attachments are maintained by third parties. TMA has no control over this information, or the goods or services provided by such third parties. TMA shall have no liability for any use or reliance of a user on the information provided by third parties.

Article on cocooning. Dr. Healy also is the director of Vaccinology and Maternal Immunization at the Center for Vaccine Awareness and Research. She summarizes their program in “The Cocoon Strategy,” a commentary published in Texas Medicine (August 2008).

DSHS Physician materials. Posters, brochures, a handbook, and a PowerPoint training presentation all focusing on the cocooning strategy are available at preventpertussis.com, which is part of an initiative started by DSHS.